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Course Web Site http://courses.washington.edu/ebmed/EBM/index.shtml You can link to this site from the Medicine Residency web page, the Roosevelt GIMC Residents’ web page, or HSL Evidence Based Practice web page.

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Evidence-based medicine is the integration of the best available research evidence with clinical expertise and patient values.

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Why Teach and Practice EBM? It is required to be taught by ABIM. Outcomes research has documented that patients who do receive evidence-based therapies have better outcomes than those who don’t. It may be a more efficient means of remaining current than traditional methods (e.g. journal subscriptions). A host of developments make EBM more possible than ever.

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Objectives Hands-on, real-time learning of skills necessary to incorporate EBM into your daily practice of medicine. Provide the opportunity to apply these skills to actual clinical encounters. Have fun learning and teaching others. Minimize work outside of day to day clinical responsibilities.

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Responsibilities Attend all the sessions. Each week during your clinical encounters generate at least one question about patient care you would like to try and answer in EBM. We will tackle these questions thematically (therapy, prognosis, diagnosis). Apply and teach what you learn.

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Steps in Practicing EBM 1.Convert the need for information into an answerable question. 2.Track down the best evidence with which to answer that question. 3.Critically appraise the evidence for its validity, impact, and applicability. 4.Integrate the evidence with our clinical expertise and our patient’s characteristics and values.

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Putting Skills into Practice Find evidence supporting one clinical decision made on each of your inpatients. Find evidence supporting one clinical decision made on one patient per clinic day. Encourage the students and colleagues you work with to follow your lead. Work as a team to find evidence-based answers.

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Steps in Practicing EBM 1.Convert the need for information into an answerable question. 2.Track down the best evidence with which to answer that question. 3.Critically appraise the evidence for its validity, impact, and applicability. 4.Integrate the evidence with our clinical expertise and our patient’s characteristics and values.

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Good questions are the backbone of practicing EBM. It takes practice to ask the well-formulated question.

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The nature of the question asked is critically experience dependent. GENERAL KNOWLEDGE SPECIFIC KNOWLEDGE TYPE OF QUESTION CLINICAL EXPERIENCE

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Differences in Type of ?’s “Background” question composed of question modifier and condition. Cover the full range of biologic, psychologic, or sociologic aspect of human illness Can be answered by reference works. * Can be used as a trampoline for generating specific questions to be answered by EBM. “Foreground” question composed of patient and/or problem, intervention (therapy, diagnostic test, etc.), comparison and outcome. Often requires more comprehensive and intensive search strategies (not necessarily more time consuming). Suitable to answering using the techniques of EBM. GeneralSpecific

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Well-Built Clinical ?’s Directly relevant to the care of the patient and our knowledge deficit. Contains the following elements: –the patient or problem being addressed –the intervention or exposure being considered –the comparison intervention or exposure, when relevant –the clinical outcomes of interest.

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Q: What is best evidence? OR Q: What kind of evidence is least likely to be wrong?

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Steps in Practicing EBM 1.Convert the need for information into an answerable question. 2.Track down the best evidence with which to answer that question. 3.Critically appraise the evidence for its validity, impact, and applicability. 4.Integrate the evidence with our clinical expertise and our patient’s characteristics and values.

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The Evidence Pyramid Validity/Strength of Inference Time Spent in Critical Appraisal

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Steps in Practicing EBM 1.Convert the need for information into an answerable question. 2.Track down the best evidence with which to answer that question. 3.Critically appraise the evidence for its validity, impact, and applicability. 4.Integrate the evidence with our clinical expertise and our patient’s characteristics and values.